12
Nov

Disability Survey

   Posted by: admin   in Uncategorized

The City of Bisbee’s Committee on Disability Issues is asking for your help so we may help you.  We are conducting a survey to determine the needs of the disabled community in the different suburbs of Bisbee, and Visitors to the Historic City of Bisbee.  This survey is completely anonymous.  We Don’t want your name, address, or phone number.  The information provided will allow us to focus our energy and resources to best serve the disabled community in Bisbee.

 

Are you Disabled?
 I am Disabled I represent someone who is Disabled

Where are you from?
 Old Bisbee San Jose Bakerville Saginaw Don Luis Lowell Warren Galena Briggs Tintown Other Out of Town Visitor

If you are/were a visitor, where are you from?

City and State

What is your age range?

What type of disability do you have? (check all that apply)
 Mobility Eyesight/Vision Hearing/Audio Mental Age/Health Other

What type of assistance/devices do you require?
 Manual Wheelchair Electric/Scooter Cane Walker Guide Dog Blind Cane Braille Print Large Print Deaf Partial Hearing Sign Language Interpretor Hearing Aid Other None

If ‘Other’ please specify:

Assistance-Needs-Devices

Would you be more active if you had better access to the following? (check all that apply)
 Accessible Pedestrian Walkways Public Transportation Public Facilities Public Pool Public Parks Public Liabrary Public Post Office Public/Municipal Buildings Public Schools Other

What accessability issues have you experienced?

Additional Message, Suggestions, Issues, or Concerns

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